Comparative Effectiveness of Four Biologics for Moderate-to-Severe Plaque Psoriasis: A Network Meta-Analysis

Multiple biologic agents targeting different inflammatory pathways are available for moderate-to-severe plaque psoriasis. While previous network meta-analyses have compared biologics, most were published before the approval of bimekizumab (the newest dual interleukin [IL]-17A/F inhibitor) and lack head-to-head comparisons incorporating this agent alongside other contemporary biologic therapies. We conducted a systematic literature search of PubMed and Clinical Trials to identify phase III randomized controlled trials comparing biologic treatments for moderate-to-severe plaque psoriasis. The primary outcome was achievement of 90% or greater reduction in Psoriasis Area and Severity Index (PASI 90) at week 16. We performed a frequentist random-effects network meta-analysis to estimate odds ratios (OR) with 95% confidence intervals (CI) for all treatment comparisons. From 642 records identified, 11 phase III randomized controlled trials (10 datasets, 6,657 patients) were included, comparing bimekizumab (IL-17A/F inhibitor), secukinumab (IL-17A inhibitor), risankizumab and guselkumab (IL-23p19 inhibitors), adalimumab (tumor necrosis factor-alpha inhibitor), ustekinumab (IL-12/23 inhibitor), and placebo. Compared with placebo, all active treatments showed significant efficacy: bimekizumab (OR 170.04, 95% CI 104.33-277.14), risankizumab (OR 95% CI 59.97-151.74), guselkumab (OR 82.25, 95% CI 51.23-132.03), secukinumab (OR 75.01, 95% CI 45.37-124.02), adalimumab (OR 30.07, 95% CI 19.16-47.18), and ustekinumab (OR 26.68, 95% CI 16.48-43.20). Network heterogeneity was low (I² = 0.0%) for most comparisons. Bimekizumab demonstrated the highest efficacy for achieving PASI 90 at week 16, followed by risankizumab, guselkumab, and secukinumab. All newer biologic agents showed substantial superiority over adalimumab and ustekinumab. These findings can inform treatment selection and guideline development for moderate-to-severe plaque psoriasis.